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1 Meaningful Use Participation Basics for the Small Provider Vidya Sellappan Centers for Medicare & Medicaid Services Office of E-Health Standards and Services HIT Initiatives Group July 30, 2014

2 EHR INCENTIVE PROGRAM BASICS 1

3 What is meaningful use? Meaningful use is using certified EHR technology to: Improve quality, safety, efficiency, and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health All the while maintaining privacy and security Meaningful use mandated by law to receive incentives 2

4 How do the EHR Incentive Programs work? The EHR Incentive Programs consist of 3 stages of meaningful use Each stage has its own set of requirements to meet in order to demonstrate meaningful use Stage 1 Data capturing and sharing Stage 2 Advanced clinical processes Stage 3 Improved outcomes

5 Who is eligible to participate? Eligibility determined by law Hospital-based eligible professionals are NOT eligible for incentives DEFINITION: 90% or more of their covered professional services in either an inpatient (POS 21) or emergency room (POS 23) of a hospital Definition of hospital-based determined in law Incentives are based on the individual, not the practice

6 What is CEHRT? CMS and the ONC established standards and other criteria for structured data that EHRs must use in order to qualify for EHR incentive payments Providers must use an EHR that is certified specifically for the EHR Incentive Programs Check the Certified EHR Technology Product List (CHPL) to determine whether your EHR is considered certified EHR technology, or CEHRT: 5

7 CEHRT requirements Q: What Certified EHR Technology do I need in 2014? A: EHR Technology certified to the 2014 criteria covering the base EHR plus all objectives I intend to attest for in Q: Does it matter if I am in Stage 1 or 2? A: No Note: Providers beyond their first year of participation may electronically report their CQMs for the full calendar year of This means providers will submit their CQM data between January 1 and February 28,

8 Meeting CEHRT There are 3 ways to meet the CEHRT definition: 1. Complete EHR - Generally provides overall assurance - EPs would still need EHR technology certified to cancer registry certification criteria if they seek to meet that meaningful use objective 2. Combination of EHR Modules 3. Single EHR Module In the case of EHR Modules, it is now possible for an eligible provider to have just enough EHR technology certified to the 2014 Edition EHR certification criteria to meet the CEHRT definition 7

9 STAGE 1 MEANINGFUL USE 8

10 What are the requirements for Stage 1 of meaningful use? EPs participating must meet the following for Stage 1: 13 required core objectives 5 objectives chosen from a list of 9 menu set objectives In addition to meeting the thresholds for the 13 core and 5 menu objectives, all EPs have to report on clinical quality measures (CQMs) Meaningful Use = MU Core Measures Menu Measures CQMs Meaningful Use Beginning in 2014, reporting CQMs will no longer be part of the 14 core measures, but will be still be required. The total of core measures will become 13.

11 What are the core objectives for Stage 1? EPs must meet all 2014 Definition core objectives: Core Objective Measure 1. CPOE Use CPOE for at least 30% of medication orders 2. Drug-drug and Drugallergy Checks Enable drug-drug and drug-allergy checks on EHR 3. Problem List Record patient diagnoses for more than 80% 4. E-Rx E-Rx for more than 40% 5. Medication List Record patient medications for more than 80% 6. Medication Allergy List Record patient medications for more than 80% 7. Demographics Record demographics for more than 50% 8. Vital Signs Record vital signs for more than 50%

13 What are the menu objectives for Stage 1? EPs must select Definition menu objectives: Menu Objective Measure 1. Drug Formulary Checks Enable the formulary check for the entire reporting period 2. Lab Results Incorporate lab results for more than 40% 3. Patient List Generate patient list by specific condition 4. Preventive Reminders Use EHR to identify and provide reminders for preventive/follow-up care for more than 20% of patients 65 years or older or 5 years old or younger 5. Education Resources Use EHR to identify and provide education resources more than 10% 6. Rx Reconciliation Medication reconciliation at more than 50% of transitions of care 7. Summary of Care Provide summary of care document for more than 50% of transitions of care and referrals 8. Immunization Registries* Submit at least one immunization registry electronically 9. Syndromic Surveillance* Perform at least one transmission of syndromic surveillance data *Must select at least 1 public health objective as part of 5

14 What do you have to do for meaningful use? To show CMS that they have meaningfully used their certified EHR, providers must meet all of the Stage 1 requirements that CMS has established: For the first year they participate, Medicare EPs* have to meet the requirements for and report data on a continuous 90-day period during the calendar year (any 90 days from January 1st to December 31st) For the remaining years they participate, Medicare EPs have to meet the requirements for the entire calendar year Both of these are called the reporting periods For 2014 only: All providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month (or 90-day) EHR reporting period in 2014 *Medicaid EPs can adopt, implement, or upgrade their EHR to CEHRT in their first year of participation, but also have the option to choose to meet meaningful use by reporting on measures for a 90-day reporting period. 13

15 What is happening in 2014? For 2014 only, all providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a 3-month or 90-day EHR reporting period: For 1 st year Medicare EPs- 90-day reporting period is not fixed to the quarter of the year For Medicare EPs in 2 nd year and beyond- 3-month reporting period is fixed to the quarter of the year in order to align with existing CMS quality measurement programs For All Medicaid EPs- 90-day reporting period is not fixed to the quarter for Medicaid EPs who are only eligible to receive Medicaid EHR incentives and do not have the same alignment needs

16 2015 registration and attestation deadline for 2014 reporting period February 28, 2015: Last day for Medicare EPs to register and attest to receive an incentive payment for calendar year 2014 EPs must submit their 2014 meaningful use data by 11:59pm ET Deadline varies for Medicaid EPs Medicare providers must attest every year

21 2014 is last year for EPs to earn a Medicare EHR incentive payment To earn their first incentive, Medicare EPs should have begun their 90-days by July 1, 2014 and should submit attestation by October 1, 2014 This earlier reporting period allows for CMS to review reported data so you can avoid the payment adjustment in 2015 EPs who did not begin by July 1 can still begin their 90-day reporting period by October 3 and receive an incentive payment, but will also be subject to a payment adjustment unless they submitted a hardship exception application by July 1 EPs who begin this year may receive a total payment of $23,520

22 Avoiding 2016 payment adjustments To avoid the 2016 payment adjustment, Medicare EPs should: Demonstrate meaningful use during one of the 2014 reporting periods and attest by: February 28, 2015 OR Apply to CMS for a hardship exception by: July 1, 2015 Medicaid EPs are not subject to payment adjustments Hospitals subtract 3 months for corresponding deadlines Notes: EP deadline to submit a hardship exception application to avoid the 2015 payment adjustment was July 1, 2015 EPs that successfully demonstrate meaningful use for the first time by October 1, 2014 will avoid both the 2015 and 2016 payment adjustments 21

23 Payment adjustments for EPs eligible for both programs Eligible for both programs? If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use according to the timelines in the previous slides to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare or Medicaid. Note: Congress mandated that an EP must be a meaningful user in order to avoid the payment adjustment; therefore receiving a Medicaid EHR incentive payment for adopting, implementing, or upgrading your certified EHR Technology does not quality for an exception for a payment adjustment.

24 What are the hardship exceptions for EPs? Medicare EPs can apply for hardship exceptions in the following categories: 1. Infrastructure EPs must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband). 2. New EPs Newly practicing EPs who would not have had time to become meaningful users can apply for a 2-year limited exception to payment adjustments. 4. EPs must demonstrate that they meet the following criteria: Lack of face-to-face or telemedicine interaction with patients Lack of follow-up need with patients 5. EPs who practice at multiple locations must demonstrate that they: Lack of control over availability of CEHRT for more than 50% of patient encounters 3. Unforeseen Circumstances Examples may include a natural disaster or other unforeseeable barrier, including EHR Vendor Issues.

25 What are the hardship exceptions for EPs? EPs whose primary specialties are anesthesiology, radiology or pathology: As of July 1 st of the year preceding the payment adjustment year, EPs in these specialties will receive a hardship exception based on the 4 th criteria for EPs EPs must demonstrate that they meet the following criteria: Lack of face-to-face or telemedicine interaction with patients Lack of follow-up need with patients

26 How do EPs apply for a hardship exceptions? Applying: EPs, eligible hospitals, and CAHs must apply for hardship exceptions to avoid the payment adjustments. Granting Exceptions: Hardship exceptions will be granted only if CMS determines that providers have demonstrated that those circumstances pose a significant barrier to their achieving meaningful use. Deadlines: Applications need to be submitted no later than April 1 for hospitals, and July 1 for EPs of the year before the payment adjustment year; however, CMS encourages earlier submission For More Info: Details on how to apply for a hardship exception will be posted on the CMS EHR Incentive Programs website in the future:

27 Audits and appeals Pre-pay and post-pay audits Findings Security risk assessments Not meeting measure thresholds Appeals of failed audits If you did not respond to auditor, there is nothing to appeal Must be filed within 30 days of the demand letter to be considered & must submit documentation with the appeal

28 Resources from CMS and ONC Get information, tip sheets and more at CMS official website for the EHR incentive programs: Introduction to EHR Incentive Programs Frequently Asked Questions (FAQs) Meaningful Use Attestation Calculator Registration & Attestation User Guides Listserv Learn about certification and certified EHRs, as well as other ONC programs designed to support providers as they make the transition:

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